scholarly journals Effect and Efficiency of an Embedded Palliative Care Nurse Practitioner in an Oncology Clinic

2017 ◽  
Vol 13 (9) ◽  
pp. e792-e799 ◽  
Author(s):  
Anne M. Walling ◽  
Sarah F. D’Ambruoso ◽  
Jennifer L. Malin ◽  
Sara Hurvitz ◽  
Ann Zisser ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Nurse Practitioner ◽  
Implementation Strategies ◽  
Care Planning ◽  
Care Nurse ◽  
Time Motion ◽  
Symptom Screening ◽  
Advance Care

Purpose: To test a simultaneous care model for palliative care for patients with advanced cancer by embedding a palliative care nurse practitioner (NP) in an oncology clinic. Methods: We evaluated the effect of the intervention in two oncologists’ clinics beginning March 2014 by using implementation strategies, including use of a structured referral mechanism, routine symptom screening, integration of a psychology-based cancer supportive care center, implementation team meetings, team training, and a metrics dashboard for continuous quality improvement. After 1 year of implementation, we evaluated key process and outcome measures for supportive oncology and efficiency of the model by documenting tasks completed by the NP during a subset of patient visits and time-motion studies. Results: Of approximately 10,000 patients with active cancer treated in the health system, 2,829 patients had advanced cancer and were treated by 42 oncologists. Documentation of advance care planning increased for patients of the two intervention oncologists compared with patients of the other oncologists. Hospice referral before death was not different at baseline, but was significantly higher for patients of intervention oncologists compared with patients of control oncologists (53% v 23%; P = .02) over the intervention period. Efficiency evaluation revealed that approximately half the time spent by the embedded NP potentially could have been completed by other staff (eg, a nurse, a social worker, or administrative staff). Conclusion: An embedded palliative care NP model using scalable implementation strategies can improve advance care planning and hospice use among patients with advanced cancer.

Impact of a Palliative Care Nurse Practitioner in an Oncology Clinic: A Quality Improvement Effort

2021 ◽  
Author(s):  
Sarah F. D'Ambruoso ◽  
John A. Glaspy ◽  
Sara A. Hurvitz ◽  
Neil S. Wenger ◽  
Christopher Pietras ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Nurse Practitioner ◽  
Care Delivery ◽  
Skills Training ◽  
Care Planning ◽  
Care Nurse ◽  
Advance Care

PURPOSE: Guidelines support early integration of palliative care (PC) into standard oncology practice; however, little is known as to whether outcomes can be improved by modifying health care delivery in a real-world setting. METHODS: We report our 6-year experience of embedding a nurse practitioner in an oncology clinic (March 2014-March 2020) to integrate early, concurrent advance care planning and PC. RESULTS: Compared with patients with advanced cancer not enrolled in the palliative care nurse practitioner program, in March 2020, patients who are enrolled are more likely to have higher quality of PC (eg, goals of care note documentation [82% v 15%; P < .01], referral to the psychosocial oncology program [67% v 37%; P < .01], and referral to hospice [61% v 34%; P < .01]) and less inpatient utilization in the last 6 months of life (eg, hospital days [12 v 18; P < .01] and intensive care unit days [1.2 v 2.3; P < .01]). The program expanded over time with the support of faculty skills training for advance care planning and PC, supporting a shared mental model of PC delivery within the oncology clinic. CONCLUSION: Embedding a trained palliative care nurse practitioner in oncology clinics to deliver early integrated PC can lead to improved quality of care for patients with advanced cancer.

Relationships between worry about dying in patients with advanced cancer and their illness understanding, treatment preferences, and advance care planning.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12080-12080
Author(s):  
Rachel Rodenbach ◽  
Andrew Althouse ◽  
Thomas J. Smith ◽  
Douglas B. White ◽  
Edward Chu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Advance Directive ◽  
Group Performance ◽  
Terminally Ill ◽  
Sensitivity Analyses ◽  
Treatment Preference ◽  
Care Planning ◽  
Advance Care

12080 Background: Patients with advanced cancer often worry about dying, yet little is known about the role their fears play regarding future care. We aimed to explore relationships between patients’ worry about dying and their illness understanding, treatment preference, and advance care planning. Methods: This cross-sectional study uses baseline data from a community-based, primary palliative care intervention trial. Patients had metastatic solid tumors, an Eastern Cooperative Oncology Group performance status of 0-2, and their oncologist “would not be surprised” if they died in the next year. Using patients’ response to “I worry about dying” (not at all, a little bit, somewhat, quite a bit, or very much) from the Functional Assessment of Chronic Illness - Palliative Care survey instrument, univariate and multivariate analyses assessed associations with illness understanding (report of being terminally ill or not), treatment preference (life-extending vs. symptom-focused), and advance care planning (completion of an advance directive or not). We also performed sensitivity analyses substituting “I feel scared about my future” (strongly disagree, disagree, agree, or strongly agree) from the Herth Hope Index for “I worry about dying.” Results: Of 672 patients, 54% were female, 94% white, and 69% currently receiving chemotherapy. 47% reported worrying about dying “not at all,” while 9.7% worried “quite a bit” or “very much.” In regression analysis, those who worried “quite a bit” or “very much” were more likely to describe themselves as terminally ill (adjusted odds ratio (AOR)=1.98, 95% CI=1.10-3.54, p=0.021) and more likely to prefer life-extending treatment over symptom-focused care (AOR=2.61, 95% CI=1.30-5.22, p=0.007) compared with patients who reported not worrying about dying. They also were less likely to have completed an advance directive (AOR=0.49, 95% CI=0.25-0.94, p=0.032). The same relationships were observed using patients’ response to “I feel scared about my future.” Conclusions: Patients with advanced cancer who worry more about dying can affirm they are terminally ill and are more likely to want life-extending treatment over symptom care while less likely to engage in advance care planning. Understanding these patients’ decision making is critical to ensuring that their values are known and understood near the end of life.

Palliative Care for Children with Advanced Cancer

2020 ◽  
pp. 83-89
Author(s):  
Michelle Koh ◽  
Finella Craig ◽  
Joanne Wolfe
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Symptom Management ◽  
Psychological Symptoms ◽  
Care Planning ◽  
Specific Symptom ◽  
Advance Care ◽  
Bereavement Care

This chapter on palliative care for children with advanced cancer addresses the challenges of decision making and the care of the child and family. It explores decision making with regards to ongoing treatment, advance-care planning, and the importance of establishing goals of care. The nature and management of common physical and psychological symptoms are examined, in particular pain and the use of opioids and neuropathic adjuvants. Cancer-directed therapies, specific symptom management, and steroids are discussed. The chapter also includes specific issues around the care of the child and family at the end of life, such as feeding, spiritual distress, and ongoing bereavement care. This chapter is aimed at professionals in the multidisciplinary team caring for children in this context.

What influences patients’ decisions regarding palliative care in advance care planning discussions? Perspectives from a qualitative study conducted with advanced cancer patients, families and healthcare professionals

2019 ◽  
Vol 33 (10) ◽  
pp. 1299-1309 ◽  
Author(s):  
Cheng-Pei Lin ◽  
Catherine J Evans ◽  
Jonathan Koffman ◽  
Shuh-Jen Sheu ◽  
Su-Hsuan Hsu ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Filial Piety ◽  
Healthcare Professionals ◽  
Care Planning ◽  
Advanced Cancer Patients ◽  
Advance Care

Background: The concept of advance care planning is largely derived from Western countries. However, the decision-making process and drivers for choosing palliative care in non-Western cultures have received little attention. Aim: To explore the decision-making processes and drivers of receiving palliative care in advance care planning discussions from perspectives of advanced cancer patients, families and healthcare professionals in northern Taiwan. Method: Semi-structured qualitative interviews with advanced cancer patients, their families and healthcare professionals independently from inpatient oncology and hospice units. Thematic analysis with analytical rigour enhanced by dual coding and exploration of divergent views. Results: Forty-five participants were interviewed ( n = 15 from each group). Three main decision-making trajectories were identified: (1) ‘choose palliative care’ was associated with patients’ desire to reduce physical suffering from treatments, avoid being a burden to families and society, reduce futile treatments and donate organs to help others; (2) ‘decline palliative care’ was associated with patients weighing up perceived benefits to others as more important than benefits for themselves; and (3) ‘no opportunity to choose palliative care’ was associated with lack of opportunities to discuss potential benefits of palliative care, lack of staff skill in end-of-life communication, and cultural factors, notably filial piety. Conclusion: Choice for palliative care among advanced cancer patients in Taiwan is influenced by three decision-making trajectories. Opinions from families are highly influential, and patients often lack information on palliative care options. Strategies to facilitate decision-making require staff confidence in end-of-life discussions, working with the patients and their family while respecting the influence of filial piety.

Does use of the POLST form implicate overall care for patients with advanced cancer syndromes?

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 15-15 ◽  
Author(s):  
Justin Lebenthal ◽  
David Barile ◽  
Ramy Sedhom
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
End Of Life ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Care Planning ◽  
Code Status ◽  
Advance Care ◽  
Cancer Syndromes ◽  
Discharge Summaries

15 Background: The POLST “Practitioner Orders for Life-Sustaining Treatments” form addresses patient goals, scope of therapies, artificial nutrition, and resuscitation status. In New Jersey, Section A offers a unique opportunity for patients to describe in their own words overall goals of care. We investigated if completion of Section A influences aggressiveness of care at end of life for patients with advanced cancer syndromes. Methods: All POLST forms completed in 2015 at the University Medical Center of Princeton were retrospectively reviewed. Patients 18 years or older, electing for DNAR/DNAI status, were eligible for inclusion. All other responses on the POLST form were collected. Chart review was used to collect admitting diagnosis, referral and/or admission to the intensive care unit, palliative care and hospice use, length of stay, number of readmissions and deaths in the hospital. Discharge summaries were reviewed to assess if advance care planning discussions were documented. Results: 57 charts were reviewed: 34% were female, age 41 to 99 (mean 82), and average LOS was 6 days. 19% preferred “symptom treatment only” on their POLST forms and 70% preferred “limited treatment.” Section A was completed for 34 of 57 patients (60%). Those completing section A were less likely to be referred to the ICU, had a shorten length of stay (5 vs. 9 days), and had fewer unexpected deaths in the hospital. In addition, those completing section A were more likely to utilize both palliative and hospices services. Though physicians rarely documented code status on discharge summaries (38%), all patients with a palliative care consult while hospitalized had advance care planning discussions documented at discharge. Conclusions: Use of the POLST form provides a very natural order for discussion of life sustaining treatments and end-of-life care. Patients completing section A were more likely to utilize palliative care, hospice services, and advance care planning. The benefits of the POLST form extends beyond patient outcomes and may positively impact the care patients with advanced cancer syndromes. The importance of individualized preferences seems logical, but larger studies are needed to validate our findings.

scholarly journals Advance Care Planning in the Time of COVID: Real-World Case Discussions

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 134-134
Author(s):  
Erica Frechman ◽  
Harleah Buck
Keyword(s):  
Palliative Care ◽  
Advance Care Planning ◽  
Real World ◽  
Implementation Strategies ◽  
Care Planning ◽  
Major Health ◽  
First Case ◽  
The Family ◽  
Advance Care

Abstract COVID has accelerated the science and practice of palliative care while creating a sense of urgency in advance care planning (ACP). Past palliative care principles and practices have been stressed to the breaking point, causing the need for new ACP approaches to elicit patient-and-family goals/values/preferences. In this presentation, two cases will be used to discuss pragmatic implications and real-world implementation strategies in the trenches of the major health care system disruptor of this generation. We will discuss access to documentation, immediacy and complexity of the decision-making process, provider impacts, role of the family, and even an upside to this crisis. This will include questions of ethics and equity. The first case involves an older man whose family disregarded his wishes, while the second case discusses the pitfalls and pearls when family cannot visit. These two cases highlight COVID’s impact on ACP and cause us to re-think its process and delivery.

Demenz aus palliativmedizinischer Perspektive: warum ein krankheitsspezifisches Advance Care Planning wichtig ist

2018 ◽  
Vol 75 (2) ◽  
pp. 105-111 ◽  
Author(s):  
Ralf J. Jox ◽  
Francesca Bosisio ◽  
Eve Rubli Truchard
Keyword(s):  
Palliative Care ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care ◽  
Menschen Mit Demenz

Zusammenfassung. Die Palliative Care muss sich im Zuge des demographischen Wandels vieler Gesellschaften rund um den Globus tiefgreifend wandeln. Sie muss mehr und mehr mit der Geriatrie zusammenarbeiten und geriatrische Expertise integrieren. Eine der zentralen Herausforderungen Geriatrischer Palliative Care ist die ethisch angemessene Therapieentscheidung für Menschen, die nicht mehr urteilsfähig sind. Nachdem der bisherige Ansatz herkömmlicher Patientenverfügungen erwiesenermassen enttäuscht hat, wird aktuell, gerade auch in deutschsprachigen Ländern, das systemische Konzept des Advance Care Planning (ACP) verfolgt. In diesem Artikel wird zunächst ACP mit seinen Zielen, Elementen und Effekten vorgestellt. Sodann wird gezeigt, weshalb es für Menschen mit Demenz eines adaptierten ACP-Programms bedarf und was ein solches demenzspezifisches ACP beinhalten muss.

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